Intercondylar Distal Femoral Fracture. An Unreported Complication of Posterior-stabilized Total Knee Arthroplasty

In an attempt to study the incidence of intraoperative femoral intercondylar fractures, two large series of posterior-stabilized total knee arthroplasty (TKA) systems were reviewed. Eight hundred ninety-eight nonconsecutive primary posterior-stabilized TKAs were compared with a second nonconsecutive series of 532 posterior-stabilized TKAs. Unique to the secondary TKA system is an intercondylar sizing guide to aid in verification of the intercondylar resection size. In the initial series, 40 distal femoral intercondylar fractures were noted (rate = 1:22; nondisplaced, 35; displaced, 5). In the secondary series, one displaced distal femoral intercondylar fracture occurred (rate = 1;532). The difference in the rate of fracture between the two populations was statistically significant (P<.001). Intraoperative distal femoral intercondylar fracture represents a potential complication of TKA and can be avoided with careful resection technique and size verification. No change in the postoperative rehabilitation program is required, however, for those patients identified with nondisplaced and intraoperative-stabilized displaced distal femoral intercondylar fractures.